Training Behavior Questionnaire

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Name
First Name
Last Name
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Primary Email
example@example.com
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Additional Assistance Program: Please advise if you have any disability, health, travel, housing, transportation, or physical issue we should be aware of that would affect your ability to participate in training your dog. We have a special program available and there may be different criteria we need to evaluate for. Space is limited, clients are accepted on a case by case basis when space is available.
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Name* This field is required.
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Ie:
New puppy/new dog

Rescue Dog Training

Service Dog or Therapy Dog Training

Problem behaviors:

Reactivity, Fear based, anxiety, on leash issues, in home issues, aggresion, resource guarding, food aggression, outward aggression, trauma based issues, shy dog program.

Why now?
- New behaviour
- Recent increase/incident/etc.
- Not resolving. Time to get help
- Situational change
- Other...
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Please describe:
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What is the main reason/problem that you are inquiring about?
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Background: When did you first notice tendencies of this problem behaviour?
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Has there been a recent change in the behaviour? (More frequent? More intense? Different circumstances?)
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How often does it occur?
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Can you anticipate when it is likely to happen? (When, where, who is present, trigger, etc.)
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Why do you think your dog is doing this?
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What have you done so far to address this problem? With what effect?
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What would you consider an acceptable goal/outcome of a training program?
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Please describe several recent incidents in as much detail as possible.Date. Time. Location. Who is present. What happened before, during and after.
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What is the secondary reason/problem that you are inquiring about?
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Background: When did you first notice tendencies of this problem behaviour?
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Has there been a recent change in the behaviour? (More frequent? More intense? Different circumstances?)
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How often does it occur?
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Can you anticipate when it is likely to happen? (When, where, who is present, trigger, etc.)
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Why do you think your dog is doing this?
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What have you done so far to address this problem? With what effect?
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What would you consider an acceptable goal/outcome of a training program?
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Please describe several recent incidents in as much detail as possible.Date. Time. Location. Who is present. What happened before, during and after.
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Check all that apply and are a concern to you and give details.
Anxiety
Aggression - People
Aggression - Dogs
Aggression - Other animals
Barking, vocalizing excessively
Chasing moving objects (bike, vehicle, etc.)
Chasing people or dogs
Counter Surfing
Demanding, attention seeking
Destructive (chewing, scratching, etc.)
Digging
Door dashing
Escaping (Fence jumping, etc.)
Fear
House soiling
Jumping up
Running off
Separation distress
Stealing food, objects
Unruly (Jumping, mouthing, etc.)
Other: humping, eating non food objects, compulsive behaviour...
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Please describe...
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Any particular dog/dog dynamics that are relevant to your inquiry?
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Veterinary Clinic
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Is your dog up to date on vaccinations and protocols as recommended by your Veterinarian?
YESNO
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If no, please advise. (ie: Titre, health, etc.)
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Allergies?
YESNO
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Medications?
YESNO
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Past relevant medical or health conditions or important medical history (allergies, medication, injury, etc)? If yes, please describe...
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Have you specifically asked your Veterinarian about any of your dog’s training and behaviour concerns? If yes, what was their advice?
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Do we have your permission to contact your Veterinarian about your dog’s behaviour?
YESNO
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Please describe your dog’s behaviour at the veterinary office?
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What are your reasons for having a dog?Companion, children, protection, specific task, etc.
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Where did you get your dog from? Include name of organization if known.Breeder, home breeding, farm, rescue, etc.
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How old was your dog when you got him/her?
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What do you know as fact about your dog’s background?Dam and sire, littermates, early puppyhood, previous home, reason for previous surrender, street dog, farm raised, abused, etc.
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What are some of your reasons for choosing this particular dog?
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Do you live in
a house
a condo
an apartment
other
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Do you have a yard?
YESNO
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Is it fenced?
YESNO
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Relevant changes or dynamics that may affect your dog:Recent move, frequent moves, job schedule change, baby, death, divorce, etc.
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Is anyone in your family afraid of, or dislike your dog?
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Is there any conflict in the home regarding your dog’s behaviour and training?
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Environment around the home:Conflict with neighbour, airport noises, playground, bus stop, etc.
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What do you feed your dog? Please be specific (Brand, variety, canned, dried, raw, homecooked, etc.)
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How food motivated is your dog? 1 - 10 (finicky ... voracious)
Please Select
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10
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Please describe your dog’s mealtime. (Where, when, how often, who feeds, special routine, etc.)
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Does your dog guard their regular meal against humans? (growl, snap, etc.)
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Please describe any treat routine your dog has. (Who, what kind of treat, etc.)
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What would your dog say that her/his favourite pastimes are?
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Play: What types of play do you engage in with your dog? Please describe.
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Exercise: What types of exercise does your dog regularly get?
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Leash Walks: Please describe: How often? Where? How does your dog act on leash?
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Walking gear: Please describe: What kind of leash, collar or harness do you use now?
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What have you tried in the past?
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Off leash time: Does your dog get off leash time? Please describe: Why or why not? Give any details.
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Muzzle: Does your dog use a muzzle for any reason?
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How long is your dog left alone on an average day?
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Where is your dog kept when you are not home?
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What does your dog do when left home alone? Fine? Okay? Anxious/distressed?
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What is your dog’s behaviour like when you leave home and return?
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Is your dog content in a crate? If no, please describe history of exposure.
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Day: What does your dog do when you are at home and not interacting with them?
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Is your dog allowed on furniture?
Yes
No
With permission
Type option 4
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Do you have any special rules and boundaries in your home, yard, etc.?
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Where does your dog rest in the day when you are home?
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Night: Where does your dog sleep at night?
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Are they a sound sleeper or easily disturbed? Settle easily? Please describe.
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Meal time: What does your dog do when you have your meals/snacks?
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How does your dog react when familiar people come to your home? Please describe: (Bark, jump, mouth, calm, etc.)
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How does your dog react when unfamiliar people come to your home? Please describe: (Bark, jump, mouth, calm, etc.)
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Does your dog join you on car rides? Please describe: (How often? Where? How does your dog act? What type of vehicle? Where in the vehicle do they ride? etc.)
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Which grooming tasks do you perform yourself? List: (Bathing, brushing, trimming, nail clipping, teeth cleaning, ear cleaning, none, other...)
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How does your dog react? Please describe: (Calm, struggle, resist certain parts, bite, use a muzzle, etc.)
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Does your dog go to a groomer?
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Is your dog fully housetrained?
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Does your dog mark indoors?
YESNO
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Does your dog urinate when excited/greeting/stressed, etc? Please describe.
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Any other details?
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Please describe: Enrichment, games, jobs, etc.
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What do you like about your dog? Name 2 or 3...
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What do you find most annoying about your dog? Yes, you can mention that ;) Name 2 or 3...
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How would you describe your dog’s personality? Rate on scale of #1 ... 10
1 Anxious ... unconcerned 10
1 Fearful ... confident 10
1 Sensitive ... resilient 10
1 Hyper ... calm 10
1 Energetic ... lazy 10
1 Impulsive ... thoughtful 10
1 Intense ... mellow 10
1 Pushy ... submissive 10
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Rate your dog’s response to the following: (0 never - 10 reliable)
Come
Down
Stay
Drop/Leave it
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What are some training goals that you would like to work towards?
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What are some of your training successes? Tricks count ;)
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What are some of your training challenges?
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How do you let your dog know when they have done something “good”?
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What are some of your dog’s favourite rewards? Be specific. Hot dogs, frisbee, butt scratches, etc.
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How do you let your dog know when they have done something “bad”?
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What types of corrections have you tried or currently use? (interrupt, redirect, time out, verbal reprimand, physical reprimand, scruff, muzzle grab, alpha roll, squirt bottle, throw chain, shake can, choke collar, pinch collar, citronella collar, electronic/stimulation/shock collar, etc.)
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With what effect? (ie: no change, stopped behaviour, got worse, only worked with certain person, etc.)
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Has your dog participated in any professional training before? If yes, please describe.Puppy class, obedience class, private, board and train? Where? Trainer's name?
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What type of methods were used?
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How was your experience and the results?
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Have you ever used the services of a trainer with a past dog? If yes, with who? Please describe the experience: (Reason, training given, outcome, etc.)
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How would you describe your dog’s sociability with other dogs in general?
dog social
dog tolerant
dog selective
dog defensive
dog aggressive
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What is your dog’s typical play style: Chase? Bully? Wrestle? Body slam? Other?
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Does your dog attend doggie day care, dog walker or a boarding facility?
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Does your dog regularly attend “Dog Parks”? If yes, please describe: park type, dog interactions, your dog’s behaviour, etc.
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Has your dog ever shown any worrisome aggressive behaviour to other dogs (lunging, growling, baring teeth, snapping, nipping, biting, etc.)?
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If yes, please describe.
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Have they bitten another dog and broken skin?
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What is the ratio of “fights” to bites? Ie: 20 fights and one bite.
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Has your dog ever been bitten by another dog? If yes, please describe.
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What is your dog’s experience with cats?
buddies/amiable
tolerates
injured/killed
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Any negative experience with other domestic animals? (horse, chickens, etc.)
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Has your dog had experiences with wildlife that worried you?
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Has your dog ever shown any worrisome aggressive behaviour to any people (lunging, growling, baring teeth, snapping, nipping, biting, etc.)?
YESNO
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If yes, please describe.
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Have they bitten and bruised or broken skin?
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In what situations does your dog tend to act aggressively towards people?
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When people approach their food, dish, bone, etc.?
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When people approach their possessions, toy, etc.?
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When people approach their bed, couch, etc.?
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When being handled, grabbed, restrained, etc.? If yes, please describe.
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If disturbed while resting or sleeping?
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When visitors come to the home and property?
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When visitors move around inside the home? If yes, please describe.
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When out on a walk and sees people in distance? If yes, please describe.
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When out and about and people pass. Jogging, on bikes, skateboards, etc.?
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When around familiar children?
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When around unfamiliar children?
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When around toddlers? If yes, please describe.
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When around babies?
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Please answer yes or no to these characteristics of your dog's aggressive behaviour.
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attacks are sudden and surprising
YESNO
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episodes appear unprovoked
YESNO
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the dog is abruptly docile after an episode
YESNO
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the dog appears "sorry" afterwards
YESNO
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the dog appears disoriented afterwards
YESNO
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episodes are associated with a "glazed" or "absent" expression
YESNO
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I can usually tell what will set off my dog
YESNO
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the aggressive behavior is new and uncharacteristic
YESNO
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Has your dog bitten and broken skin?
YESNO
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Number of bites that broke skin:
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Total number of bites (that did or did not break skin):
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Total number of episodes of aggression (growling, snapping, biting):
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Please describe typical episode (does dog growl, lunge or bite, and in what circumstance?):
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If the dog is in the above situation 10 times, in how many of those times is aggression seen (all=100%, just one=10%, etc.)?
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What parts of the body has the dog bitten and how severe were the injuries?
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Who is/are the target(s) of aggression?
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Did your dog show worrisome behaviour as a puppy?
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How old was your dog the first time he/she growled at a person?
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Is there anything else that you would like us to know about your situation or your dog?
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RATE FROM 1 – 6

1 - I would like to learn more but the problem is not serious
2 - I would like to change problem but it is not serious
3 - The problem is serious and I would like to change it, but if it remains unchanged that’s all right.
4 - The problem is very serious and I would like to change it, but if it remains unchanged I will keep my dog.
5 - The problem is very serious and I would like to change it; if it remains unchanged I will have my dog euthanized or give him/her up.
6 - I have almost given up already and am seriously considering having my dog euthanized or giving him/her up.
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Please rate:
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How much time per day total are you able to dedicate to training? (in 10-minute increments. ie: total 1 hour)
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Thank you for taking the time to complete this form. Consider recording any incidents in chronological order and recording any new information and share with us before or on the day of our session.
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AddressPlease list the address the dog lives, is fostered, or housed at.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Phone Number
Area Code
Phone Number
Should be Empty: